Method for the management of incontinence

ABSTRACT

A composition and a dosage form are disclosed comprising oxybutynin alone/or accompanied by another drug indicated for therapy. A method is disclosed for administering oxybutynin alone/or accompanied by a different drug or for administering oxybutynin and a different drug according to a therapeutic program for the management of incontinence alone, and for other therapy.

CROSS-REFERENCE TO RELATED APPLICATION

[0001] This application is a continuation-in-part of U.S. patentapplication Ser. No. 08/806,773 filed Feb. 26, 1997, which applicationis a continuation-in-part of U.S. patent application Ser. No. 08/706,576filed Sep. 5, 1996, now U.S. Pat. No. 5,840,754 issued Nov. 24, 1998,which is a continuation-in-part of U.S. patent application Ser. No.08/445,849 filed May 22, 1995, now U.S. Pat. No. 5,674,895 issued Oct.7, 1997, benefit is claimed of these applications, that are assigned tothe ALZA Corporation of Palo Alto, Calif.

FIELD OF THE INVENTION

[0002] This invention pertains to the management of incontinence. Morespecifically the invention relates to the management of incontinence byadministering to a patient having the symptoms of incontinence atherapeutically effective dose of oxybutynin alone, in combination withanother drug, proceeded by the administration of another drug, orfollowed by the administration of another drug.

BACKGROUND OF THE INVENTION

[0003] Many people are affected by urinary incontinence. Incontinence isparticularly common in the elderly, urinary incontinence is present inapproximately fifty percent of nursing home patients, and urinaryincontinence is a well known urologic problem in women. It will affectnearly all women in some form during their lifetime, and it is ofsignificant medical and social concern to all humans who experience it.Urinary incontinence arises from the anatomy and from the physiology ofthe urinary tract, which is composed of a bladder and a sphincter.Anatomically, the bladder consists of the bladder musculature, alsoknown as detrusor, and the trigone. The sphincter includes the bladderneck and the proximal urethra. The detrusor muscle is innervated by thepelvic nerve through the parasympathetic nervous system, and the bladderneck and proximal urethra are innervated by the sympathetic nervoussystem.

[0004] The major functions of the bladder are the storage and expulsionof urine. The bladder is responsible for accommodating increasingvolumes of urine at low pressures. Normally, the bladder remains closedduring bladder filling and continence is maintained as long as thebladder neck and urethral pressure exceeds intravesical pressure.Voluntary voiding occurs when intravesical pressure exceeds bladder neckand urethral pressure, and involuntary voiding also known as involuntaryincontinence occurs when the travesical pressure exceeds the bladderneck and urethral pressure. Involuntary incontinence also known as urgeincontinence and overactive bladder, occurs with a loss of a largevolume of urine accompanied by symptoms of urgency, frequency andnocturia caused by an unstable bladder or detrusor instability. Thepatient may lose urine with a change in position or with auditorystimulation. The loss of small volumes of urine usually occurs becausebladder overdistension by a large amount of residual urine referred toas overflow incontinence. Urinary incontinence is also known asoveractive bladder with symptoms of urinary frequency or urgeincontinence.

[0005] The present management of incontinence consists in administeringa smooth muscle relaxant, such as oxybutynin, which acts directly on thesmooth muscle at the site distal to the cholinergic receptor. The priorart administered oxybutynin alone for this stated therapeutic purpose.The prior art usual dose for the pharmacologic management ofincontinence is repeated, nonsustained and noncontrolled doses fromtwo-to-four times a day for oxybutynin. The prior art administeredseparately the steriods, estrogen and/or progesterone hormonereplacement therapy however, this steroid therapy is insufficient forthe management of incontinence.

[0006] In light of the above presentation it will be appreciated bythose versed in the medical and pharmaceutical dispensing arts to whichthis invention pertains that a pressing need exists for a therapeuticmethod that can deliver the therapeutic drug oxybutynin in a controlled,sustained-extended dose to a patient in clinical need of incontinencemanagement. The pressing need exists for an oral method of therapy thatcan deliver oxybutynin alone at a substantially sustained releaseconstant dose per unit time for its therapeutic effect. The need existsadditionally for a method for delivering a dose of oxybutyninonce-a-day, when indicated, for its intended therapy while avoiding anoverdose and for lessening the side effects that can accompany the drug.The pressing need exists further for a method that can administeroxybutynin in combination with another and different drug, or indifferent therapeutic programs for the management of incontinence andfor the management of health and disease.

[0007] It will be appreciated by those skilled in the medical andpharmaceutical arts to which this invention pertains, that if a noveland unique method of administration is made available that deliversoxybutynin alone, or in combination with another drug in atherapeutically effective dose over a sustained time for the managementof incontinence, while lessening the incidence of over and under dose,such a method of therapy would represent an advancement and a valuablecontribution for providing practical therapy.

SUMMARY OF THE INVENTION

[0008] According to the invention, it is an object of the invention toprovide a method for the management of urinary incontinence withoxybutynin and/or its pharmaceutically acceptable salt alone, or incombination with another drug, or preceeded by or followed by theadministration of another drug, for the management of incontinence inhuman male and female patients. The object of the invention furthercomprises a method for administering oxybutynin alone, and/or incombination with or preceded by or followed by an estrogen and/or aprogestin for treating urinary incontinence in pregnant, non-pregnant,postpartum, menopause, post menopausal, and during climaterix period ofchange occurring in the transition to menopause in a patient in need oftherapy.

DETAILS OF THE INVENTION

[0009] The scientific terms and scientific phrases used in thisspecification embrace the following definitions: Dosage form denotes adrug delivery system for administering a therapeutically effective doseof drug, for example oxybutynin to a patient in need of therapy. Thedosage form may be administered once-daily, that is, as a once-a-daydosage form for increasing patient compliance for treating overactivebladder, or more frequently as indicated by a physician, for exampletwice-daily or thrice-daily. Sustained release denotes the constantdelivery of drug for up to twenty-hours. Controlled release denotes thedelivery of the drug at a rate controlled by a dosage form by the methodof the invention. Zero-order release denotes the method of delivery ofdrug at a uniform rate to dampen the peaks and valleys observed innon-zero order method of drug delivery. Therapeutically effective amountdenotes the dose of delivered drug sufficient to provide a local or asystemic effect in a patient. Menopause denotes the period of naturalcessation of menstruation in the female. Post menopausal denotes thetime occurring after menopause. Pregnancy denotes the state ofcontaining an unborn fetus within the female. Postpartum denotes theperiod following birth.

[0010] The present invention provides a therapeutic compositioncomprising 240 ng to 650 mg (nanogram to milligrams) of oxybutynin or anoxybutynin therapeutically acceptable salt. The pharmaceuticallyacceptable salt is selected from the group consisting of acetate,bitartrate, citrate, edetate, chloride, edisylate, estolate, esylate,fumarate, gluceptate, gluconate, glutamate, hydrobromide, hydrochloride,lactate, malate, maleate, mandelate, mesylate, methylnitrate, mucate,napsylate, nitrate, pamoate, pantothenate, phosphate, salicylate,stearate, succinate, sulfate, tannate, and tartrate. The drug oxybutynincan be present as the racemate, as the R-enantiomer or as theS-enantiomer. The oxybutynin and its pharmaceutically acceptable saltcan be administered at a controlled mean release rate of 0.10 ng perhour to 25 mg per hour for the management of incontinence up to 24hours. The dosage forms provided by the invention can administeroxybutynin in doses such as 5 mg, 10 mg, 15 mg, 20 mg etc. for themanagement of incontinence. The oxybutynin can be administered alone, orin therapeutic programs with another and different drug, from the samedosage form or from different dosage forms.

[0011] Representative of a drug, for example a steroid, that can beadministered with prior to or followed by the administration ofoxybutynin, according to the method of the invention in the same or inan accompanying method, at the same or at a different time, or the drugcan be administered separately within up to twenty-four hour periodcomprise a progestin member selected from the group consisting ofprogesterone, medroxyprogesterone, medroxyprogestrone acetate,hydroxyprogesterone, hydroxyprogesterone caproate, norethindrone,norethindrone acetate, megestrol, megestrol acetate, progestin,progestogin, norgestrel, norethisterone, norethisterone acetate,levonorgestrel, norgestimate, norethynodrel, 17-hydroxyprogesteroneesters, 19-nor-17-hydroxyprogesterone, 19-nor-17-hydroxyprogesteroneesters, 17α-ethinyltestosterone, 17α-ethinyl-19-nor-testosterone,d-17β-acetoxy-13β-ethyl-17α-ethinyl-17β-hydroxygon-4-en-3-one,13β-ethyl-17β-hydroxygon-4-en-3-one,13β-17β-diethyl-17β-hydroxygon-4-en-3-one, chlormadione acetate,dimethistrone, 17α-ethinyl-β-acetoxy-19-norandrost-4-en-3-one oxime,3-ketodesogestrel, desogestrel, gestodene, and gestodene acetate. Thedose of the progestin and its progrestone derivatives administered is 10ng to 600 mg, that is administered alone, or in combination with anestrogen, and is indicated for hormone replacement therapy.

[0012] Representative of a drug that can be administered with oxybutyninaccording to the method of the invention, or administered separately ina separate administration in twenty-four hours include an estrogensteroid possessing estrogenic activity selected from the groupconsisting estradiol, estradiol valerate, estradiol benzoate, estradiolcypionate, estradiol propionate, estradiol dipropionate, estradiolacetate, ethinyl estradiol, 17α-ethinyl estradiol-esters, 17α-ethinylestradiol acetate, 17α-ethinyl estradiol benzoate, 17α-ethinyl estradiolethers, estrone, estrone acetate, estrone sulfate, estriol, estriolsuccinate, estriol triacetate, conjugated equine estrogens, andestradiol esters. The dose of estrogen and its estrogen derivatives is10 ng to 600 mg, that is administered alone, or in combination with aprogestin for hormone replacement therapy.

[0013] Representative of progestin and estrogen combination that can beadministered according to the methods of this invention comprise ahormone pair selected from the group consisting of progestin andestradiol valerate, progestin and piperazine estrone, progestin andestrone, progestin and estriol, progestin and conjugated equineestrogens, progesterone and estradiol, progesterone and estrone,progesterone and estriol, progesterone and conjugated equine estrogens,norethisterone and estradiol, medoxyprogesterone and estradiol,norgestrel and estradiol, dyhrogesterone and estrogen, progestrone andestrogen sulfate, progesterone and 17α-dihydroequilin, and progesteroneand equilenin.

[0014] The method of the invention provides oxybutynin and the steroidscan be administered from the same dosage form, or the oxybutynin and thesteroids can be administered separately from different dosage forms,with in either administrations, the oxybutynin and the steroids, in onepresent administration, administered within a twenty-four therapeuticperiod.

[0015] The method of the invention further provides delivery means foradministering oxybutynin at a rate conducive for lessening theconversion of oxybutynin at least in part to the desethyl metabolite,desoxy. The method provides for the controlled and sustained rate atwhich oxybutynin is delivered to the plasma to lessen the circulatingdesoxy metabolite and to reduce side effect associated therewith. Themethod provides for oxybutynin delivery to a patient at a rate whichgives an oxybutynin/desoxy metabolite ratio higher than 0.18:1 and/orthe plasma level of the desoxy metabolite do not exceed 350 ng·h/ml, tolessen side effects. According to this feature of the invention there isprovided a desethyl metabolite of α-cyclohexyl-α-hydroxy-benzeneaceticacid-4-(diethyl amino)-2-butynyl ester, or its pharmaceuticallyacceptable salt so the desethyl metabolite does not exceed 350 ng·h/ml,and may even exhibit peak levels of 250 or 200 ng·h/ml.

[0016] The method for delivering oxybutynin neat, and/or other drugsaccording to the invention comprises, in one manufacture the use of drugreleasing beads that on dissolution or diffusion release the drug over24 hours. The drug releasing beads comprise a central composition orcore comprising a drug and pharmaceutically acceptable compositionforming ingredients including an optional lubricant, antioxidant, andbuffer. The beads are medical preparations with a general diameter of 1mm to 2 mm. The beads comprise doses of drug, for example, 1 mg, 2 mg,10 mg, and 20 mg, increasing up to 40 mg. The beads in an embodiment areformed of noncrossed-linked materials to enhance their discharge fromthe gastrointestional tract. The beads are coated with a release ratecontrolling polymer that give a timed released profile. The timedrelease beads are manufactured into a tablet for therapeuticallyeffective drug administration. The beads are made into matrix tablets bythe direct compression of a plurality of beads coated with, for example,an acrylic resin and blended with excipients such ashydroxypropylmethylcellulose. The manufacture of beads is disclosed inInter. J. of Pharm., by Lu, Vol. 112, pp. 117-124 (1994); Pharm. Sci.,by Remington, 14^(th) Ed. pp. 1626-1628 (1970); J. Pharm. Sci., byFincher, Vol. 57, pp. 1825-1835 (1968); and U.S. Pat. No. 4,083,949. Themanufacture of the tablet is described in Pharmaceutical Sciences, byRemington, 17^(th) Ed., Chp. 90, pp. 1603-1625, (1985), published byMack Publishing Co., Easton, Pa.

[0017] The method for delivering oxybutynin alone, or in combinationwith another drug comprises in another embodiment the use of oxybutynincoated on a polymer substrate. The polymer can be an erodible, or anon-erodible polymer. The coated substrate is folded onto itself toprovide a bilayer polymer drug dosage form. For example, 1 ng to 40 mgoxybutynin alone, or in combination with an estrogen, or in combinationwith an estrogen-progestin pair is coated onto a polymer such as apolypeptide, collagen, gelatin, polyvinyl alcohol, polyorthoester,polyacetyl, or a polyorthocarbonate, and the coated polymer folded ontoitself to provide a bilaminated dosage form. In operation, thebioerodible dosage form erodes at a controlled rate to dispensed atherapeutic dose of oxybutynin alone, or oxybutynin and a steroid pairover a sustained release period. Representative biodegradable polymercomprise a member selected from the group consisting of biodegradablepoly(amides), poly(amino acids), poly(esters), poly(lactic acid),poly(glycolic acid), poly(carbohydrate), poly(orthoester),poly(orthocarbonate), poly(acetyl), poly(anhydrides), biodegradablepoly(dehydropyrans), and poly(dioxinones). The polymers are known to theart in Controlled Release of Drugs, Rosoff, Chp. 2, pp. 53-95 (1989);and in U.S. Pat. Nos. 3,811,444; 3,962,414; 4,066,747, 4,070,347;4,079,038; and 4,093,709.

[0018] The method of the invention further uses a dosage form comprisinga polymer that releases a drug by diffusion through a polymer, or byflux through pores, or by rupture of a polymer matrix. The drug deliverypolymeric dosage form comprises a concentration of 10 ng to 250 mghomogenously contained in or on a polymer. The dosage form comprises atleast one exposed surface at the beginning of dose delivery. Thenonexposed surface when present is coated with a pharmaceuticallyacceptable material impermeable to the passage of drug. The dosage formcan be manufactured by procedures known to the prior art. An example ofproviding a dosage form comprises blending a pharmaceutically acceptablecarrier, like polyethylene glycol, with a known dose of oxybutyninalone, or oxybutynin and an estrogen, at an elevated temperature, like37° C., and adding it to a silastic medical grade elastomer with across-linking agent, for example, octanoate, followed by casting in amold. The step is repeated for each optional successive layer. Thesystem is allowed to set, for 1 hour, to provide the dosage form.Representative polymers for manufacturing the dosage form comprise amember selected from the group consisting of olefin and vinyl polymers,addition polymers, condensation polymers, carbohydrate polymers, andsilicon polymers as represented by poly(ethylene), poly(propylene),poly(vinyl acetate), poly(methyl acrylate), poly(isobutyl methacrylate),poly(alginate), poly(amide), and poly(silicone). The polymers andmanufacturing procedures are known in Polymers, by Coleman et al., Vol.31, pp. 1187-1231 (1990); Drug Carrier Systems, by Roerdink et al., Vol.9, pp. 57-109 (1989); Adv. Drug Delivery Rev., by Leong et al., Vol. 1,pp. 199-233 (1987); Handbook of Common Polymers, Compiled by Roff etal., (1971), published by CRC Press; and U.S. Pat. No. 3,992,518.

[0019] The method of the invention also uses a dosage form comprising amatrix comprising a plurality of tiny pills. The timed released tinypills provide a number of individual doses for providing various timeddoses for achieving a sustained-release drug delivery profile over 24hours. The matrix comprises a hydrophilic polymer selected from thegroup consisting of a polysaccharide, agar, agarose, natural gum, alkalialginate including sodium alginate, carrageenan, fucoidan, furcellaran,laminaran, hypnea, gum arabic, gum ghatti, gum karaya, grum tragacanth,locust bean gum, pectin, amylopectin, gelatin, and a hydrophiliccolloid. The hydrophilic matrix comprises a plurality of 4 to 50 tinypills, each tiny pill comprising a dose population of from 10 ng, 0.5mg, 1 mg, 1.2 mg, 1.4 mg, 1.6 mg, 5.0 mg, etc. The tiny pills comprise arelease rate controlling wall of 0.001 up to 10 mm thickness to providefor the 9 timed release of drug. Representative of wall-formingmaterials include a triglyceryl ester selected from the group consistingof glyceryl tristearate, glyceryl monostearate, glyceryl dipalimitate,glyceryl laureate, glyceryl didecenoate and glyceryl tridenoate. Otherwall forming materials comprise polyvinyl acetate phthalate,methylcellulose phthalate, and microporous vinyl olefins. Procedure formanaufacturing tiny pills are disclosed in U.S. Pat. Nos. 4,434,153;4,721,613; 4,853,229; 2,996,431; 3,139,383, and 4,752,470.

[0020] The method of the invention also comprises administering orallyto a human patient a dosage form comprising a semipermeable wall thatsurrounds a therapeutic composition comprising oxybutynin. In use withina patient, the osmotic dosage form comprising a homogenous compositionimbibes fluid through the semipermeable wall into the dosage form inresponse to the concentration gradient across the semipermeable wall.The therapeutic composition in the dosage form develops osmotic energythat causes the therapeutic composition to be administered through anexit from the dosage form over a prolonged period of time up to 24 hours(or even in some cases up to 30 hours) to provide controlled andsustained oxybutynin therapy. The method of the invention also uses inanother embodiment an osmotic dosage form comprising a wall surroundinga compartment, the wall comprising a semipermeable polymeric compositionpermeable to the passage of fluid and substantially impermeable to thepassage of oxybutynin present in the compartment; an oxybutynin druglayer composition in the compartment comprising the oxybutynin; ahydrogel push layer composition in the compartment comprising an osmoticformulation for imbibing and absorbing fluid for expanding in size forpushing the oxybutynin composition layer from the dosage form; and atleast one passageway in the wall for releasing the oxybutynin. Themethod delivers the oxybutynin, alone or in combination with a steroidby imbibing fluid through the semipermeable wall at a fluid imbibingrate determined by the permeability of the semipermeable wall and theosmotic pressure across the semipermeable wall causing the push layer toexpand; and thereby deliver the therapeutically active oxybutynin fromthe dosage form through the exit passageway to a patient over aprolonged period of time up to 24 or even 30 hours. The oxybutyninadministered by the dosage form of the invention is in the therapeuticrange that avoids a toxic dose and avoids an ineffective dose forantispasmodic therapy. The oxybutynin may thus be administered by themethods of this invention to patients with uninhibited neurogenic andreflex neurogenic bladder for increased vessel capacity which diminishesthe frequency of uninhibited contractions of the detrusor muscle anddelays the desire to void. The dosage form is indicated for the reliefof symptoms associated with voiding such as urgency, urge incontinence,frequency, nocturia and incontinence in patients in neurogenic bladder.The dosage form can be used also for human hormone replacement therapyas described above.

[0021] The osmotic dosage forms in one manufacture comprise atherapeutic composition comprising 240 ng to 650 mg of a member selectedfrom the group consisting of oxybutynin and its pharmaceuticallyacceptable salt, from 10 mg to 350 mg of a pharmaceutically acceptablehydrogel such as a polyalkylene oxide of 75,000 to 750,000weight-average molecular weight. Representative of polyalkylene oxidesare polyethylene oxide of 100,000 weight-average molecular weight,polyethylene oxide of 200,000 weight-average molecular weight,polyethylene oxide of 300,000 weight-average molecular weight,polyethylene oxide of 600,000 weight-average molecular weight, andpolypropylene oxide of 100,000 weight average molecular weight. Thetherapeutic composition may also comprise 0 mg to 50 mg, in a presentmanufacture 1 mg to 50 mg of a hydroxypropylalkylcellulose of 9,000 to150,000 average-number molecular weight selected from the groupconsisting of hydroxypropylmethylcellulose, hydroxypropylethylcellulose,hydroxypropylbutylcellulose, and hydroxypropylpentylcellulose, 0 to 20mg of a hydroxyalkylcellulose, such as hydroxypropylcellulose; 0 mg to50 mg, in a present manufacture 1 mg to 50 mg, of an osmotic soluteselected from the osmotically effective compounds consisting of sodiumchloride, potassium chloride, potassium acid phosphate, tartaric acid,citric acid, raffinose, magnesium sulfate, magnesium chloride, urea,inositol, sucrose, glucose and sorbitol; and 0.00 mg to 7.5 mg and onemanufacture 0.01 mg to 5 mg of a lubricant, such as calcium stearate,zinc stearate, magnesium stearate, magnesium oleate, calcium palmitate,sodium suberate, potassium laureate, salts of fatty acids, salts ofalicyclic acids, salts of aromatic acids, stearic acid, oleic acid,palmitic acid, and a mixture of salt of fatty, alicyclic or aromaticacid and a fatty, alicyclic or aromatic acid.

[0022] The invention provides for the therapeutic composition comprisingthe drug oxybutynin to be administered as the composition neat, that is,oxybutynin alone, for increasing the urinary bladder capacity, fordiminishing the frequency of uninhibited contractions of the detrusormuscles and its accompanying delay of the desire to void. The inventionprovides for the therapeutic oxybutynin composition to be surrounded bya wall comprising a semipermeable composition with an exit fordelivering the therapeutic composition to a human patient in need ofoxybutynin therapy. The invention provides, in an additional embodiment,the therapeutic composition comprising oxybutynin as a therapeutic layerin layered, contacting arrangement with a hydrogel expansion compositionmanufactured as a layer that supports the therapeutic composition toyield a bilayered matrix. The hydrogel layer composition may comprise 10mg to 350 mg of a hydrogel, such as a member selected from the groupconsisting of a polyalkylene oxide of 1,000,000 to 8,000,000 which areselected from the group consisting of polyethylene oxide of 1,000,000weight-average molecular weight, a polyethylene oxide of 2,000,000molecular weight, a polyethylene oxide of 4,000,000 molecular weight, apolyethylene oxide of 5,000,000 molecular weight, a polyethylene oxideof 7,000,000 molecular weight, and a polypropylene oxide of the1,000,000 to 8,000,000 weight-average molecular weights; or 10 mg to 250mg of an alkali carboxymethylcellulose of 10,000 to 6,000,000weight-average molecular weight such as sodium carboxymethylcellulose orpotassium carboxymethylcellulose. The hydrogel expansion layeredcomprises 0.0 mg to 350 mg, in present manufacture 0.1 mg to 250 mg of ahydroxyalkylcellulose of 7,500 to 4,500,000 weight-average molecularweight, represented by hydroxymethylcellulose, hydroxyethylcellulose,hydroxypropylcellulose, hydroxybutylcellulose, andhydroxypentylcellulose; 0 mg to 50 mg, in present manufacture 1 mg to 50mg of an osmagent selected from the group consisting of sodium chloride,potassium chloride, potassium acid phosphate, tartaric acid, citricacid, raffinose, magnesium sulfate, magnesium chloride, urea, inositol,sucrose, glucose and sorbitol; 0 to 5 mg of a colorant, such as ferricoxide; 0 mg to 30 mg, in a present manufacture, 0.1 mg to 30 mg of ahydroxypropylalkylcellulose of 9,000 to 225,000 average-number molecularweight, selected from the group consisting ofhydroxypropylethylcellulose, hydroxypropypentylcellulose,hydroxypropylmethylcellulose, and hydropropylbutylcellulose; 0.00 to 1.5mg of an antioxidant selected from the group consisting of ascorbicacid, butylated hydroxyanisole, butylatedhydroxyquinone,butylhydroxyanisol, hydroxycomarin, butylated hydroxytoluene, cephalm,ethyl gallate, propyl gallate, octyl gallate, lauryl gallate,propylhydroxybenzoate, trihydroxybutylrophenone, dimethylphenol,dibutylphenol, vitamin E, lecithin and ethanolamine; and 0.0 mg to 7 mgof a lubricant selected from the group consisting of calcium stearate,magnesium stearate, zinc stearate, magnesium oleate, calcium palmitate,sodium suberate, potassium laureate, salts of fatty acids, salts ofalicyclic acids, salts of aromatic acids, stearic acid, oleic acid,palmitic acid, a mixture of a salt of a fatty, alicyclic or aromaticacid, and a fatty, alicyclic, or aromatic acid.

[0023] The invention provides for the therapeutic oxybutynincomposition, the therapeutic bilayer comprising the drug oxybutyninlayer, and the osmopolymer hydrogel layer to be administered as thecomposition or the bilayer per se; that is, as the composition or thebilayer together for increasing the urinary bladder capacity, fordiminishing the frequency of uninhibited contractions of the detrusormuscles and its accompaying delay of the desire to void. The inventionprovides additionally for the therapeutic composition and for thecompositional bilayer to be surrounded by a wall comprising asemipermeable composition with an exit for delivering the therapeuticcomposition to a human patient in need of oxybutynin therapy. Theinvention also provides for a subcoat to surround the therapeuticcomposition or to surround the bilayer, which subcoat in eitherembodiment is surrounded by a outer semipermeable wall.

[0024] The invention provides a dosage form for the delivery of thetherapeutic composition comprising oxybutynin. The dosage form comprisesup to 650 mg, and provides a sustained release at a controlled rate upto 25 mg, of oxybutynin or its salt up to 24 hours. The dosage formcomprises a wall, which wall surrounds an internal lumen or compartment.The wall comprises a semipermeable composition that is permeable to thepassage of fluid and impermeable to the passage of oxybutynin. The wallis nontoxic and it comprises a polymer selected from the groupconsisting of a cellulose acylate, cellulose diacylate, cellulosetriacylate, cellulose acetate, cellulose diacetate and cellulosetriacetate. The wall comprises 75 wt % (weight percent) to 100 wt % ofthe cellulosic wall-forming polymer; or, the wall can compriseadditionally 0.01 wt % to 80 wt % of polyethylene glycol, or 1 wt % to25 wt % of a cellulose ether selected from the group consisting ofhydroxypropylcellulose or hydroxypropylalkycellulose such ashydroxypropylmethylcellulose. The total weight percent of all componentscomprising the wall is equal to 100 wt %. The internal compartmentcomprises the therapeutic oxybutynin composition alone or in layeredposition with an expandable hydrogel composition. The expandablehydrogel composition in the compartment increases in dimension byimbibing the fluid through the semipermeable wall, causing the hydrogelto expand and occupy space in the compartment, whereby the drugcomposition is pushed from the dosage form. The therapeutic layer andthe expandable layer act together during the operation of the dosageform for the release of oxybutynin to a patient over time. The dosageform comprises a passageway in the wall that connects the exterior ofthe dosage form with the internal compartment. The osmotic powereddosage form provided by the invention delivers oxybutynin from thedosage form to the patient at a zero order rate of release over a periodof 24 hours.

[0025] The expression “passageway” as used herein comprises means andmethods suitable for the metered release of the therapeutic drug fromthe compartment of the dosage form. The exit means comprises at leastone passageway, including orifice, bore, aperture, pore, porous element,hollow fiber, capillary tube, channel, porous overlay, or porous elementthat provides for the osmotic controlled release of oxybutynin. Thepassageway includes a material that erodes or is leached from the wallin a fluid environment of use to produce at least one controlled-releasedimensioned passageway. Representative materials suitable for forming apassageway, or a multiplicity of passageways comprise a leachablepoly(glycolic) acid or poly(lactic) acid polymer in the wall, agelatinous filament, poly(vinyl alcohol), leachable polysaccharides,salts, and oxides. A pore passageway, or more than one pore passageway,can be formed by leaching a leachable compound, such as sorbitol, fromthe wall. The passageway possesses controlled-release dimensions, suchas round, triangular, square and elliptical, for the metered release ofoxybutynin from the dosage form. The dosage form can be constructed withone or more passageways in spaced apart relationship on a single surfaceor on more than one surface of the wall. The expression “fluidenvironment” denotes an aqueous or biological fluid as in a humanpatient, including the gastrointestional tract. Passageways andequipment for forming passageways are disclosed in U.S. Pat. Nos.3,845,770; 3,916,899; 4,063,064; 4,088,864 and 4,816,263. Passagewaysformed by leaching are disclosed in U.S. Pat. Nos. 4,200,098 and4,285,987.

DESCRIPTION FOR MANUFACTURING THE COMPOSITIONS AND DOSAGE FORMS OF THEINVENTION

[0026] The wall of dosage forms can be formed by using an air suspensionprocedure. This procedure consists of suspending and tumbling thecomposition or the layers in a current of air and wall-formingcomposition until a wall is applied to the oxybutynin formingcompartment. The air suspension procedure is well suited forindependently forming the wall. The air suspension procedure isdescribed in U.S. Pat. No. 2,799,241; J. Am. Pharm. Assoc., Vol. 48, pp.451454 (1959); and ibid, Vol. 49, pp. 82-84 (1960). The wall can beformed with a wall-forming composition in a Wurster® air suspensioncoater using an organic solvent, such as acetone-water cosolvent 90:10(wt:wt) with 2.5 wt % to 7 wt % polymer solids. An Aeromatic® airsuspension coater using, for example, a methylene dichloride-methanolcosolvent comprising 87:13 (v:v) can be used for applying the wall.Other wall-forming techniques, such as pan coating system, wall formingcompositions deposited by successive spraying of the composition or thebilayered arrangement, accompanied by tumbling in a rotating pan can beused for the present purpose. A larger volume of cosolvent can be usedto reduce the concentration of polymer solids to produce a thinner wall.Finally, the wall of the coated compartments are laser or mechanicallydrilled, and then dried in a forced air or humidity oven for 1 to 3 daysor longer to free the solvent. Generally, the walls formed by thesetechniques have a thickness of 2 to 20 mils (0.051 to 0.510 mm) with apreferred thickness of 2 to 6 mils (0.051 to 0.150 mm).

[0027] The dosage forms of the invention are manufactured by standardmanufacturing techniques. For example, in one manufacture the beneficialdrug oxybutynin and/or additional drugs such as an estrogen, a steroidpair such as an estrogen and a progestin, and other ingredientscomprising a therapeutic composition or comprising the drug compositionthat faces the exit means are blended, or they are blended then pressedinto a composition. The oxybutynin and other ingredients can be blendedwith a solvent and then formed into a solid or semisolid formed byconventional manufacturing methods such as ball-milling, calendaring,sitrring, or roll-milling and then pressed into a selected shape. Thecomposition possesses dimensions that correspond to the internaldimensions of the area it occupies in the dosage form. In themanufacture of bilayered compositions dosage form, the bilayers possesdimensions corresponding to the internal lumen of the dosage form.First, the hydrogel expansion layer is placed in contact with theoxybutynin layer. The layering of the oxybutynin layer and the hydrogellayer can be fabricated by conventional press-layering techniques.Finally, the two-layer compartment forming members are surrounded andcoated with an outer wall. A passageway is drilled by laser ormechanically drilled through the wall, or the wall is provided with apore-former to contact the oxybutynin layer, with the dosage formoptically oriented automatically by the equipment for laser forming thepassageway on the preselected drug surface.

[0028] In another manufacture, the dosage forms are manufactured by thewet granulation technique. In the wet granulation technique theoxybutynin and/or other drugs, and the ingredients comprising the drugcomposition are blended using an organic or inorganic solvent, such asisopropyl alcohol-methylene dichloride 80:20 (v:v) as the granulationfluid. Other granulating fluid, such as water, isopropyl alcohol, ordenatured alcohol 100% can be used for this purpose. The ingredientsforming the drug composition are individually passed through a 40 meshscreen and then thoroughly blended in a mixer. Next, other ingredientscomprising the drug composition are dissolved in a portion of thegranulation fluid, such as the cosolvent described above. Then, thelatter prepared wet blend is slowly added to the drug oxybutynin blendwith continual mixing in the blender. The granulating fluid is addeduntil a wet blend mass is produced, which wet mass is then forcedthrough a 20 mesh screen onto oven trays. The blend is dried for 18 to24 hours at 25° C. to 40° C. The dry granules are then screened with a16 mesh screen. Next, a lubricant is passed through an 60 mesh screenand added to the dry screened granule blend. The granulation is put intomilling jars and mixed on a jar mill for 2 to 10 minutes. The first andsecond layer compositions are pressed into a layered tablet, forexample, in a Manesty® layer press.

[0029] Another manufacturing process that can be used for providing aoxybutynin and hydrogel composition comprises blending their powderedingredients in a fluid bed granulator. After the powdered ingredientsare dry blended in the granulator, a granulating fluid, for example,poly(vinylpyrrolidone) in a solvent, such as in water, is sprayed ontothe respective powders. The coated powders are then dried in agranulator. This process coats the ingredients present therein whilespraying the granulating fluid. After the granules are dried, alubricant, such as stearic acid or magnesium stearate, is blended asabove into the mixture. The granules are then pressed in the mannerdescribed above. In another embodiment, when the fluid bed granulatingprocess is used to manufacture the hydrogel layer, the antioxidantpresent in the polyalkylene oxide can be removed during the processingstep. If antioxidant is desired it can be added to the hydrogelformulation, and this can be accomplished during the fluid bedgranulation process.

[0030] The dosage forms of this invention are manufactured in anotherembodiment by mixing the oxybutynin with composition-forming ingredientsand pressing the composition into a layer possessing dimensions thatcorrespond to the internal dimensions of the compartment space adjacentto a passageway. In another embodiment, the oxybutynin and other drugcomposition forming ingredients and a solvent are mixed into a solid, orsemi-solid, by conventional methods such as ball-milling, calendaring,stirring or roll-milling, and then pressed into a preselected,layer-forming shape. The invention provides further a method ofmanufacturing a sustained release dosage form adapted for managingoxybutynin and its desethylmetabolite in plasma by incorporating aneffective amount of oxybutynin or its salt in a controlled releasedosage form that releases oxybutynin continuously at a controlled rateto provide a higher oxybutynin concentration and a lowerdesethylmetabolite concentration than provided by an immediate releasedosage form that dose-dumps. An immediate release dosage form generallydose-dumps its drug in an hour or less, as it lack prolonged delivery.

[0031] In the manufactures as presented above, the manufacturecomprising a composition or comprising a layer of a compositioncomprising a hydrogel osmopolymer and an optional osmagent are placed incontact with the layer comprising the drug oxybutynin, and the twolayers comprising the layers are surrounded with a semipermeable wall.The layering of the first drug oxybutynin composition and the secondhydrogel osmopolymer and optional osmagent composition can beaccomplished by using a conventional two-layer tablet press technique.The wall can be applied by molding, spraying or dipping the pressedshapes into wall-forming materials. Another technique that can be usedfor applying the wall is the air suspension coating procedure. Thisprocedure consists in suspending and tumbling the two layers in acurrent of air until the wall forming composition surrounds the layers.Manufacturing procedures are described in Modern Plastics Encyclopedia,Vol. 46, pp. 62-70 (1969); and in Pharmaceutical Sciences, by Remington,14^(th) Ed., pp. 1626-1680 (1970), published by Mack Publishing Co.,Easton, Pa. The dosage form can be manufactured by following theteaching in U.S. Pat. Nos. 4,327,725; 4,612,008; 4,783,337; 4,863,456;and 4,902,514.

[0032] The dissolution of a drug indicates the drug entering intosolution upon its delivery from a dosage form provided by this inventionis measured by the following procedure. First, a drug receivingsolution, such as, gastrointestinal fluid, hydrochloric acid, or anaqueous sodium dodecyl sulfate, 1% (w/v) (weight/volume) solution isused as the dissolution media. A dosage form prepared by this inventionis placed into the dissolution media and the drug released by the dosageform into the dissolution media is sampled at a constant time intervalover the time period of dissolution. The filtered samples are assayed bya reversed high pressure liquid chromatography, or detection by UV. Theconcentration of the samples is measured against a standard curvecontaining, for example, at least five standard points. Procedures fordissolution testing are reported in The United States Pharmacopoeia, TheNational Formulary, pp. 1791 to 1796; (1995); Pharmaceutical Sciences,by Remington, 17^(th) Ed., pp. 653-666 (1985); and USP XXII, DissolutionPaddle Analysis, pp. 1578-1579 (1990).

[0033] The release rate of drug from a dosage form manufactured by thisinvention can be ascertained by the following procedure. The procedurecomprises placing the dosage form in a solution, usually water, andtaking aliquots of the release rate solution, followed by theirinjection into a chromatographic system to quantify the amount of drugreleased during specified test intervals. The drug, for example, isresolved on a column and detected by UV absorption. Quantitation isperformed by linear regression analysis of peak areas from a standardcurve containing at least five standard points.

[0034] The release rate procedure comprises attaching a dosage form to aplastic rod with the orifice exposed to the drug receiving solution.Then, attaching the rod to a release arm, with the arm affixed to anup/down reciprocating shaker, which operates at an amplitude of about 3cm and 2 seconds per cycle. Then, continuously immersing the dosage formin 50 ml test tubes containing 30 ml of H₂O, equilibrated in a constanttemperature water bath at 37° C.±0.5° C. Next, at the end of eachinterval, transfer the dosage form to the next row of new test tubescontaining a receiving solution, such as water. After the releasepattern is complete, remove the tubes and allow to cool to roomtemperature, followed by filling the calibrated tubes to the 50 ml markwith a solvent, such as acetone. The samples are mixed immediately,transferred to sample vials, followed by chromatography analysis.

[0035] Exemplary solvents suitable for manufacturing the wall, thecomposition layers and the dosage form include inert inorganic andorganic solvents that do not adversely harm the materials, the wall, thelayer, the composition and the drug wall. The solvents broadly includemembers selected from the group consisting of aqueous solvents,alcohols, ketones, esters, ethers, aliphatic hydrocarbons, halogenatedsolvents, cycloaliphatics, aromatics, heterocyclic solvents, andmixtures thereof. Typical solvents include acetone, diacetone alcohol,methanol, ethanol, isopropyl alcohol, butyl alcohol, methyl acetate,ethyl acetate, isopropyl acetate, n-butyl acetate, methyl isobutylketone, methyl propyl ketone, n-hexane, n-heptane, ethylene glycolmonoethyl ether, ethylene glycol monoethylacetate, methylene dichloride,ethylene dichloride, propylene dichloride, carbon chloroform,nitroethane, nitropropane, tetrachloroethane, ethyl ether, isopropylether, cyclohexane, cyclo-octane, toluene, naphtha, 1,4-dioxane,tetrahydrofuran, diglyme, aqueous and nonaqueous mixtures thereof, suchas acetone and water, acetone and methanol, acetone and ethyl alcohol,methylene dichloride and methanol, and ethylene dichloride and methanol.

DISCLOSURE OF EXAMPLES PROVIDED BY THE INVENTION

[0036] The following examples are merely illustrative of the presentinvention and they should not be considered as limiting the scope of theinvention in any way. These examples and other equivalents thereof willbecome apparent to those versed in the art in the light of the presentdisclosure and the accompanying claims.

Example 1

[0037] A therapeutic oxybutynin composition for administering to apatient and for use in the invention was prepared as follows: First, 103grams of oxybutynin hydrochloride was dissolved in 1200 ml (milliliters)of anhydrous ethanol. Separately, 2,280 g of polyethylene oxide of200,000 weight-average molecular weight, 150 g ofhydroxypropylmethylcellulose of 9,200 average-number molecular weightand 450 g of sodium chloride were dry blended in a conventional blenderfor 10 minutes to yield a homogenous blend. Next, the oxybutynin ethanolsolution was added slowly to the blend, with the blender continuouslyblending until all the ingredients were added to the three component dryblend, with the blending continued for another 8 to 10 minutes. Theblended wet composition was passed through a 16 mesh screen and driedovernight at a room temperature of 72° F. (22.2°). Then, the drygranules were passed through a 20 mesh screen, 18 g of magnesiumstearate was added, and all the ingredients blended again for 5 minutes.The fresh granules are ready for formulation into a therapeuticoxybutynin composition. The therapeutic composition comprises 3.4 wt %oxybutynin hydrochloride, 76 wt % polyethylene oxide of 200,000weight-average molecular weight, 5 wt % of hydroxypropylmethylcelluloseof 9,200 average-number molecular weight, 15 wt % sodium chloride, and0.6 wt % magnesium stearate. The therapeutic composition can beadministered for its intended oxybutynin therapy, the management ofoveractive bladder.

Example 2

[0038] An osmopolymer hydrogel composition for use in the invention wasprepared as follows: first 1274 g of pharmaceutically acceptablepolyethylene oxide comprising a 7,500,000 weight-average molecularweight, 600 g of sodium chloride, and 20 g of colorant ferric oxide wereseparately screened through a 40 mesh screen. Then, all the screenedingredients were mixed with 100 g of hydroxypropylmethylcellulose of11,200 average-number molecular weight to produce a homogenous blend.Next, 300 ml of denatured anhydrous alcohol was added slowly to theblend with continuous mixing for 5 minutes. Then, 1.6 g of butylatedhydroxytoluene was added, followed by more blending, with 5 g ofmagnesium stearate added with 5 minutes of blending, to yield ahomogenous blend. The freshly prepared granulation is passed through a20 mesh screen and allowed to dry for 20 hours at 22.2° C. The finalcomposition comprised 63.67 wt % polyethylene oxide of 7,500,000weight-average molecualr weight, 30 wt % sodium chloride, 1 wt % ferricoxide, 5 mg hydroxypropylmethylcellulose of 11,200 average-numbermolecular weight, 0.08 wt % butylated hydroxytoluene, and 0.25 mgmagnesium stearate.

Example 3

[0039] An osmopolymer hydrogel composition for use in the invention wasprepared as follows: first 1274 g of pharmaceutically acceptable sodiumcarboxymethylcellulose comprising a 2,250,000 weight-average molecularweight, 600 g of sodium chloride, and 20 g ferric oxide were separatelyscreened through a 40 mesh screen. Then, all the screened ingredientswere mixed with 100 g of hydroxypropylmethylcellulose of 11,200average-number molecular weight and 100 g of hydroxypropylcellulose of30,000 average-number molecular weight to produce a homogenous blend.Next, 300 ml of denatured anhydrous alcohol was added slowly to theblend with continuous mixing for 5 minutes. Then, 1.6 g of butylatedhydroxytoluene was added, followed by more blending, with 5 g ofmagnesium stearate added with 5 minutes of blending, to yield ahomogenous blend. The freshly prepared granulation was passed through a20 mesh screen and allowed to dry for 20 hours at 22.2° C. The finalcomposition comprised 58.67 wt % the sodium carboxymethylcellulose, 30wt % sodium chloride, 1 wt % ferric oxide, 5 mg ofhydroxypropylmethylcellulose, 5 mg hydroxypropylcellulose, 0.08 wt %butylated hydroxytoluene, and 0.25 mg of magnesium stearate.

Example 4

[0040] The therapeutic oxybutynin composition and the osmopolymerhydrogel composition were made into a bilayered tablet as follows:first, 147 mg of the oxybutynin composition as prepared in Example 1 wasadded to a punch die set and tamped. Then, 98 mg of the hydrogelcomposition as prepared in Example 2 was added and the two layerscompressed under a pressure head of 1.0 ton (1000 kg) into a 11/32 inch(0.873 cm) diameter, contacing intimate bilayered tablet. The examplewas repeated with the hydrogel composition as prepared in Example 3 toproduce the tablet comprising two layers.

Example 5

[0041] The bilayered tablet for example as described in Example 4 wasmanufactured into a dosage form as follows: first, a semipermeablewall-forming composition was prepared comprising 95 wt % celluloseacetate having a 39.8% acetyl content, and 5 wt % polyethylene glycolhaving a number-average molecular weight of 3350 by dissolving theingredients in a cosolvent comprising acetone and water in 90:10 wt:wtcomposition to make a 4% solid solution. The wall-forming compositionwas sprayed onto and around the bilayered cores as prepared in Examples2 and 3 to provide a 26.4 mg semipermeable wall.

[0042] Next, the semipermeable walled, bilayered tablet was laserdrilled to provide a 20 mil (0.51 mm) orifice to contact the oxybutyninlayer and the exterior of the dosage form. The residual solvent wasremoved by drying for 48 hours at 50° C. and 50% relative humidity.Next, the dosage forms were dried further for 1 hour at 50° C. to removeexcess moisture. The dosage form provided by this manufacture provides3.4 wt % oxybutynin hydrochloride, 76 wt % polyethylene oxide of 200,000weight-average molecular weight, 5 wt % hydroxypropylmethylcellulose of9,200 average-number molecular weight, 0.6 wt % magnesium stearate, and15 wt % sodium chloride in the therapeutic oxybutynin compositon. Theosmopolymer hydrogel push composition comprises 63.67 wt % polyethyleneoxide of 7,500,000 weight-average molecular weight, 30 wt % sodiumchloride, 1 wt % ferric chloride, 5 wt % hydroxypropylmethylcellulose of9,200 average-number molecular weight, 0.08 wt % butylatedhydroxytoluene, and 0.25 wt % magnesium stearate. The semipermeable wallcomprises 95 wt % cellulose acetate comprising 39.8% acetyl content, and5 wt % polyethylene glycol of 3350 number-average molecular weight. Thedosage form comprises an exit passage of 20 mils (0.50 mm) and it has amean release rate of 0.260 mg/hr for 23.8 hours. The semipermeable wallprovides substantial protection from photo (light) degradation of theoxybutynin in the dosage form.

Example 6

[0043] A dosage form is prepared according to the above examples,comprising a drug layer comprising of 6.67 wt % oxybutyninhydrochloride, 87.83 wt % polyethylene oxide of 200,000 weight-averagemolecular weight, 4.00 wt % hydroxypropylmethylcellulose of 9,200average-number molecular weight, and 0.50 wt % magnesium stearate; inlayered contact with a push hydrogel layer comprising 58.75 wt % sodiumcarboxymethylcellulose of 6,000,000 weight-average molecular weight, 30wt % sodium chloride, 5.00 wt % hydroxypropylmethylcellulose of 9,200average-number molecular weight, 1.00 wt % ferric oxide, 5.00 wt %hydroxypropylcellulose of 75,000 average-number molecular weight and0.25 wt % magnesium stearate; which bilayered core is surrounded by asemipermeable wall comprising cellulose acetate and polyethylene glycol;and an exit port through the wall for delivering the oxybutynin at acontrolled rate over thirty hours.

Example 7

[0044] The dosage form according to Example 6 wherein in the drugcomposition the polyethylene oxide has a 300,000 weight-averagemolecular weight; the hydroxypropylcellulose is a member selected fromthe group consisting of 25,000, 30,000, or 40,000 average-numbermolecular weight; and the dosage form comprises 5 mg to 250 mg ofoxybutynin pharmaceutically acceptable salt.

Example 8

[0045] A dosage form was prepared according to the above exampleswherein the dosage form of this example comprises a drug oxybutyninlayer comprising 5 mg oxybutynin, 111.60 mg polyethylene oxide of200,000 weight-average molecular weight, 7.35 mghydroxypropylmethylcellulose of 9,200 average-number molecular weight,0.88 mg magnesium stearate, 22.05 mg of sodium chloride, and 0.12 mg ofbutylated hydroxytoluene; a hydrogel push layer comprising 62.40 mg ofpolyethylene oxide of 7,000,000 weight-average molecular weight, 29.40mg of sodium chloride, 4.90 mg hydroxypropylmethylcellulose of 9,200average-number molecular weight, 0.08 mg of butylated hydroxytoluene,0.98 mg of red ferric oxide, and 0.24 mg of magnesium stearate; a wallcomprising cellulose acetate consisting of a 39.8% acetyl content andpolyethylene glycol of 3350 number-average molecular weight in thepercentage ratio of 95 wt % celluloe acetate to 5 wt % polyethyleneglycol, and exit means in the wall.

Example 9

[0046] A dosage form was prepared according to the examples provided bythis invention wherein the dosage form comprises: a drug anticholinergicoxybutynin layer comprising 5.3 wt % oxybutynin, 82.37 wt % polyethyleneoxide of 200,000 weight-average molecular weight, 2 wt %hydroxypropylmethylcellulose of 9,200 average-number molecular weight,0.25 wt % magnesium stearate, 10 wt % sodium chloride, and 0.08 wt %butylated hydroxytoluene; a push hydrogel layer comprising 63.37 wt %polyethylene oxide of 2,000,000 weight-average molecular weight, 30 wt %sodium chloride, 5 wt % hydroxypropylmethylcellulose of 9,200average-number molecular wegith, 0.08 wt % butylated hydroxytoluene, 1wt % black ferric oxide and 0.25 wt % magnesium stearate; a wallcomprising 99 wt % cellulose acetate comprising a 39.8% acetyl contentand 1 wt % polyethylene glycol of 3350 number-average molecular weight;and an exit passageway through the wall for delivering the oxybutynin toa patient, for treatment of symptoms in neurogenic bladder.

Example 10

[0047] An oxybutynin compositon was prepared according to the aboveexamples, wherein the composition comprises 10.6% oxybutyninhydrochloride, 79.57 wt % polyethylene oxide of 200,000 weight-averagemolecular weight, 2 wt % hydroxypropylmethylcellulose of 9,200average-number molecular weight, 0.25 wt % of magnesium stearate, 7.5 wt% of sodium chloride, and 0.08 wt % butylated hydroxytoluene.

Example 11

[0048] An oxybutynin composition was prepared according to the aboveexamples wherein the composition comprises 16 wt % oxybutyninhydrochloride, 76.67 wt % polyethylene oxide of 200,000 weight-averagemolecular weight, 2 wt % hydroxypropylmethylcelluose of 9,200average-number molecular weight, 0.25% magnesium stearate, 5 wt % sodiumchloride, and 0.08 wt % butylated hydroxytoluene.

Example 12

[0049] A hydrogel composition was prepared according to the aboveexamples wherein the composition comprises 58.75 wt %hydroxyethylcellulose of 1,300,000 weight-average molecular weight, 30wt % sodium chloride, 10 wt % polyvinylpyrrolidone of 42,000viscosity-average molecular weight, 1 wt % colorant red ferric oxide,and 0.25 wt % magnesium stearate.

Example 13

[0050] A dosage form was prepared according to the present inventionwherein the dosage form comprises: a drug layer comprising 3.4 wt %oxybutynin hydrochloride, 76 wt % polyethylene oxide of 200,000weight-average molecular weight, 5 wt % hydroxypropylmethylcellulose of9,200 average-number molecular weight, 0.6 wt % magnesium stearate, 15wt % sodium chloride, a push hydrogel layer comprising 58.75 wt %hydroxyethylcellulose of 1,300,000 average-number molecular weight, 30wt % sodium chloride, 10 wt % polyvinylpyrrolidone of 42,000viscosity-average molecular weight, 1 wt % red ferric oxide, and 0.25 wt% magnesium stearate; a wall comprising 95 wt % cellulose acetatecomprising a 39.8% acetyl content, and 5 wt % polyethylene glycol of3350 number-average molecular weight, an exit orifice of 20 mil (0.50mm); and a release rate of 0.292 mg per 1 hour for 16.9 hours.

Example 14

[0051] A dosage form was manufactured according to the present exampleswherein the dosage form comprises: a drug oxybutynin compositioncomprising 3.4 wt % oxybutynin hydrochloride, 76 wt % polyethylene oxideof 200,000 weight-average molecular weight, 5 wt %hydroporpylmethylcellulose of 9,200 average-number molecular weight, 0.6wt % of magnesium stearate, and 15 wt % sodium chloride; a push hydrogelcomposition for pushing the drug oxybutynin composition form the dosageform comprising 63.67 wt % polyethylene oxide of 7,000,000weight-average molecular weight, 30 wt % sodium chloride, 1 wt % redferric oxide, 5 wt % hydroxypropylmethylcellulose of 9,200average-number molecular weight, 0.08 wt % butylated hydroxytoluene, and0.25 wt % magnesium stearate; a subcoat that surrounds the drugoxybutynin composition and push hydrogel composition wherein the subcoatcomprises 95 wt % hydroxyethylcellulose, a nonionic water solublepolymer of 90,000 average-number molecular weight; then an outer wall orovercoat comprising 95 wt % cellulose acetate possessing an acetylcontent of 39.8% and 5 wt % polyethylene glycol of 3,350 number-averagemolecular weight; a 20 mil (0.50 mm) exit passageway; and an oxybutyninrelease rate of 0.295 mg per 1 hour over 19.9 hours.

Example 15

[0052] A dosage form designed and shaped as a pharmaceuticallyacceptable tablet for the oral administration of a member selected fromthe group consisting of oxybutynin and its pharmaceutically acceptablesalts was made by following the above examples. The dosage form providedby the example comprises a drug composition weighing 92 mg comprising5.45 wt % of oxybutynin hydrochloride, 9.98 wt % of sodium chloride,82.16 wt % of polyethylene oxide of 100,000 of weight-average molecularweight, 2.00 wt % of hydroxypropylmethylcellulose of 11,300 ofaverage-number molecular weight, 0.25 wt % of magnesium stearate, 0.08wt % of butylated hydroxytoluene, and 0.05 wt % of green ferric oxide.The composition was surrounded by a wall comprising a semipermeablecellulose acetate polymer comprising a 39.8% acetyl content andpolyethylene glycol comprising a 3,350 molecular weight. The dosage formcomprised an exit in communication with the oxybutynin composition fordelivering oxybutynin to the gastrointestinal tract of a patient.

Example 16

[0053] A dosage form adapted as an orally administrable caplet was madeaccording to the above examples. The dosage form of this examplecomprises a drug composition weighing 92 mg and comprising 5.45 wt %oxybutynin hydrochloride, 9.98 wt % sodium chloride, 82.19 wt %polyethylene oxide possessing a 200,000 weight-average molecular weight,2.00 wt % hydroxypropylmethylcellulose of 11,300 molecular weight, 0.25wt % magnesium stearate, 0.08 wt % butylated hydroxytoluene, and 0.05 wt% colorant green ferric oxide; a push composition initially in contactwith the drug composition, weighing 62 mg and comprising 63.67 wt %polyethylene oxide possessing a 2,000,000 weight-average molecularweight, 30.00 wt % sodium chloride, 5.00 wt %hydroxypropylmethylcellulose of 11,200 molecular weight, 1.00 wt % of a95.5 mixture of colorant black iron oxide/lactose, 0.25 wt % magnesiumstearate, and 0.08 wt % butylated hydroxytoluene; a wall weighing 19 mgthat surrounds the compositions and comprises 99 wt % of celluloseacetate of 39.8% acetyl content, and 1.00 wt % polyethylene glycol of3,350 molecular weight; a yellow color overcoat weighing 10 mg; and anexit in the wall for delivering the drug to a patient. The dosage formexhibited a cumulative release of oxybutynin bydrochloride of greaterthan zero mg to 1 mg in 0 to 4 hours, 1 mg to 2.5 mg in 0 to 8 hours,2.75 mg to 4.25 mg in 0 to 14 hours, and 3.75 mg to 5 mg in 0 to 24hours.

Example 17

[0054] A dosage form for the oral administration of oxybutynin was madeby following the above examples. The dosage form comprises a 92 mg drugcomposition comprising 10.90 wt % oxybutynin hydrochloride, 7.48 wt %sodium chloride, 79.25 wt % polyethylene oxide possessing a 200,000weight-average molecular weight, 1.99 wt % hydroxypropylmethylcellulosepossessing a 11,300 molecualr weight, 0.25 wt % magnesium stearate, 0.08wt % butylated hydroxytoluene, and 0.25 wt % magnesium stearate, 0.08 wt% butylated hydroxytoluene, and 0.05 wt % colorant red ferric oxide; apush composition weighing 62 mg and comprising 63.67 wt % polyethyleneoxide possessing a 2,000,000 weight-average molecular weight, 30 wt %sodium chloride, 5 wt % hydroxypropylmethylcellulose possessing a 11,300molecular weight, 1.00 wt % colorant black iron oxide/lactose (95:5),0.25 wt % magnesium stearate, and 0.08 wt % butylated hydroxytoluene; asemipermeable wall that envelopes the compositions weighting 19 mgcomprising 99 wt % cellulose acetate comprising a 39.8 acetyl content,and 1 wt % polyethylene gylcol 3350; a exit in the wall; and a 10 mgcolor overcoat. The dosage form, when in operation operates by osmotickinetics, and delivers in 0 to 4 hours up to 20% (up to 2 mg) ofoxybutynin hydrochloride, in 0 to 8 hours 20 to 50% (2.0 to 5.0 mg) ofoxybutynin salt; in 0 to 14 hours 50 to 85% (5.5 mg to 8.5 mg) ofoxybutynin; and 0 to 24 hours greater than 75% (greater than 7.5 mg) ofthe drug. The dosage form can be manufactured shaped like apharmaceutically acceptable tablet, or the dosage form can bemanufactured shaped like a pharmaceutically acceptable capsule.

Example 18

[0055] A dosage form for the oral delivery of a member selected from thegroup consisting of oxybutynin and its pharmaceutically acceptable saltswas made according to the above examples. The dosage form comprised adrug composition weighing 92 mg comprising 16.30 wt % oxybutyninchloride, 4.98 wt % sodium chloride, 76.35 wt % polyethylene oxide of200,000 molecular weight, 1.99 wt % hydroxypropylmethylcellulose, 0.25wt % magnesium stearate, 0.08 wt % butylated hydroxytoluene, 0.02 wt %black iron oxide/lactose (95:5); a push composition weighing 62 mgcomprising 63.67 wt % polyethylene oxide possessing a 2,000,000molecular weight, 30.00 wt % sodium chloride, 5.00hydroxypropylmethylcellulose of 11,300 molecular weight, 1.00 wt % blackiron oxide/lactose (95:5), 0.25 wt % magnesium stearate, and 0.08 wt %butylated hydroxytoluene; a wall weighing 19 mg comprising asemipermeable composition permeable to a fluid flux, impermeable to drugflux comprising 99.00 wt % cellulose acetate having a 39.8 acetylcontent, and 1.00 wt % polyethylene glycol 3350; a passageway in thewall; and a overcoat weighing 10 mg colored grey. The dosage formexhibited a cumulative release rate of up to 3 mg in 0 to 4 hours; 3 mgto 7.5 mg in 0 to 8 hours; 8 mg to 13 mg in 0 to 14 hours; and 12 mg to15 mg in 0 to 24 hours.

Example 19

[0056] A dosage form was prepared according to the previous examplescomprising an oxybutynin salt, that delivers up to 1.60 mg in 0 to 4hours, up to 5 mg in 0 to 8 hours, up to 8.5 mg in 0 to 12 hours, up to11 mg in 0 to 16 hours, and up to 15 mg in 0 to 24 hours.

Example 20

[0057] An orally administrable dosage form comprising 1 mg to 100 mg ofa drug selected from the group consisting of oxybutynin and itspharmaceutically acceptable salt is prepared by following the previousexamples, for administering accompanied by a different drug, or prior toor after the administration of conjugated equine estrogens.

Example 21

[0058] A dosage form is prepared according to the above examples whereinthe dosage form of this example comprises a drug oxybutynin steroidcomposition comprising 5 mg oxybutynin, 0.3 mg conjugated estrogens,111.60 mg polyethylene oxide of 200,000 weight-average molecular weight,7.35 mg hydroxypropylmethylcellulose of 9,200 average-number molecularweight, 0.88 mg magnesium stearate, 22.05 mg of sodium chloride, and0.12 mg of butylated hydroxytoluene; a hydrogel push compositioncomprising 62.40 mg of polyethylene oxide of 7,000,000 weight-averagemolecular weight, 29.40 mg of sodium chloride, 4.90 mghydroxypropylmethylcellulose of 9,200 average-number molecular weight,0.08 mg of butylated hydroxytoluene, 0.98 mg of red ferric oxide, and0.24 mg of magnesium stearate; a wall comprising cellulose acetateconsisting of a 39.8% acetyl content and polyethylene glycol of 3350number-average molecular weight in the percentage ratio of 95 wt %cellulose acetate to 5 wt % polyethylene glycol, and an exit passagewayin the wall.

Example 22

[0059] A dosage form is prepared according to the previous example,wherein the dosage form comprises a drug composition comprisingoxybutynin in a dose of 5 mg to 20 mg of oxybutynin and at least one ofa steroid member selected from the dose group consisting of 0.3 mg,0.625 mg, 0.9 mg, 1.25 mg and 2.5 mg of a mixture of estrogen sulfates,estrone, equilin, 17α-dihydroequilin, 17α-estradiol, equilenin and17α-dihydroequilenin indicated for treating urge incontinence, thesymptoms associated with menopause, and hormone replacement therapy.

Example 23

[0060] A bioerodible dosage form is prepared comprising a bioerodiblepolymer in matrix dosage form comprising 5 mg of oxybutynin and 0.3 mgof an estrogen that provides for the drugs release at controlled rate bythe bioeroding matrix over 24 hours. The bioerodible polymer forming thedosage form matrix comprises a member selected from the group consistingof poly(ester), poly(amine), poly(lactide), poly(glycolide),poly(lactide-co-glycolide), poly(caprolactone), poly(hydroxybutyninacid), poly(orthoester), poly(orthocarbonate), poly(dihydropyran),poly(3-hydroxybutyrate-co-3-hydroxyvalerate), andpoly(3-hydroxybutyrate-co-hydroxybutyrate). An additional dosage formcan be prepared according to the example that administers a memberselected from oxybutynin and its pharmaceutically acceptable salt and 30μg ethinyl estradiol and 150 μg of levonorgestrel.

Example 24

[0061] A diffusion rate-controlled dosage form that comprises adiffusion-rate controlled polymer through which oxybutynin and a steroidis released by diffusion is prepared by formulating oxybutynin and amember selected from the group consisting of a progestin and estrogenpair, and an estrogen, in a polymer matrix. The diffusion can be throughthe polymer or through a porous-polymer membrane. The diffusion dosageform structurally includes a polymer matrix that is a reservoir for thedrug(s), or through a contacting polymer rate-governing membrane.Representative of polymers for providing diffusional dosage formscomprise a member selected from the group consisting of poly(olefin),poly(vinyl), poly(carbohydrate), poly(peptide), poly(condensation),poly(rubber), and poly(silicon). Representative of specific polymersconsists of a member selected from the group consisting ofpoly(ethylene), poly(propylene), copoly(ethylene-vinyl acetate),poly(isobutylethylene), poly(vinylaurate), cross-linkedpoly(vinylalcohol), poly(methacrylate), poly(amide), poly(ester), andpoly(silicone).

Example 25

[0062] A dosage form comprising ion-exchange activity is prepared and itcomprises a water-insoluble crosslinked polymer with oxybutynin andestrogen bound to the ion-exchange resin. The drugs are released at arate controlled by the drug-resin complex by the ionic environmentwithin the gastrointestinal tract. The ion-exchange resins that can beadapted for the manufacture of the dosage form comprise acation-exchange resin and an anion-exchange resin. The cation-exchangeresins include strong-acid and weak-acid resins as with sulfonic acid,carboxylic acid, and phosphonic acid and the anion-exchange resinsinclude strong-base and weak-base resins as with quaternary ammonium,secondary amine, tertiary amine aromatic and tertiary amine aliphaticresins. Specific examples of ion-exchange resins such as AmberliteIR-120, basic ion-exchange resins such as Amberlite IRA-400, and weakbasic ion-exchange resins such as Amberlite IR-45.

Example 26

[0063] A method of manufacturing a sustained release dosage form formanaging the concentration of oxybutynin and its desethylmetabolite inplasma, is provided, which method of manufacture comprises theincorporation of an effective amount of oxybutynin or itspharmaceutically acceptable salt in a sustained and controlled releasedosage form which release oxybutynin continuously at a controlled zeroorder rate to provide a relatively higher oxybutynin concentration and arelatively lower desethylmetabolite concentration than provided by animmediate release non-sustained dosage form profile.

Method of Practicing the Invention

[0064] The drug oxybutynin, identified as OXY, was administered in aclinical study to a number of patients to treat urinary incontinence.Patients who self-administered oxybutynin often quit or discontinuetreatment due to its anti-cholinergic side effects, which appear to bepeak-concentration related. The present invention thus provides asustained release (SR) controlled-release (CR) oral dosage formcomprising oxybutynin designed to provide both oxybutynin therapythrough the entire gastrointestional tract and a continuous plasma drugconcentration that avoid peak and valley concentrations. The sustainedrelease dosage form of this invention continuously delivers oxybutyninthroughout the entire gastrointestional tract (GI), thereby making itstherapeutically effective for oxybutynin to be absorbed throught theentire gastrointestional tract into the blood. That is, thecontrolled-extended release dosage form of this invention maintains atherapeutic plasma concentration substantively free of an overdose andsubstantially free of an ineffective underdose of oxybutynin.

[0065] In a multiple dose, crossover study, 13 healthy female volunteersof 41 to 68 years of age received either 5 mg of oxybutynin immediaterelease (IR) every 8 hours, or three 5 mg controlled release (CR) once aday, for four days. The patients blood was sampled on days 1 and 4 toquantify oxybutynin and its desethylmetabolite (DESOXY) by liquidchromatography mass spectroscopy (LC/MS). The oxybutynin was absorbedrapidly following immediate-release (IR) dosing with a mean C_(max) ofng/ml. C_(max) is the maximum concentration after dosing in the plasma.The drug release kinetics for the controlled-release (CR) plasmaconcentration rose slowly, reaching a mean C_(max) value of 4.2-6.7ng/ml. The metabolite DESOXY was formed rapidly following immediaterelease, and its formation parallelled the slow absorption of oxybutyninfollowing controlled release. The DESOXY had a shorter t_(1/2) lifecompared to OXY, indicating presystemic metabolite formation assuming itto be true metabolite t_(1/2). Single and multiple dose AUC values weresimilar for both the controlled release and immediate release suggestingtime invariant pharmacokinetics. AUC denotes the area under the plasmaconcentration profile. The 4 day OXY and DESOXY AUC and their ratios arepresented in the Table below wherein BA denotes the percentbioavailable, that is, BA denotes the relative amount of oxybutyninabsorbed from the controlled release (CR) dosage form compared to theimmediate release (IR) dosage form, and C_(max) denotes the maximumconcentration. DESOXY OXY(AUC) (AUC) OXY/DESOXY OXY DESOXY (ng · h/mL)(ng · h/mL) Ratio (BA %) (BA %) IR 81 483 0.18 CR 109 304 0.41 153 69

[0066] The higher ratio of OXY-BA following CR compared to IR suggestslower metabolic formation on first pass. This indicates CR could reachthe colon within 3-5 hours post dosing. Presystemic cytochromeP450-mediated oxidation may occur in the upper part of thegastrointestinal tract; then, drug release from CR in the colon escapespresystemic metabolism, which could explain the higher OXY/DESOXY ratioand increased OXY BA following CR.

[0067] The dosage form and the oxybutynin composition of this invention,as seen from the above disclosure, can be used in a method foradministering a drug by the oral route, or the dosage form andcomposition can be sized and shaped for administering a drug by thesublingual and buccal routes. The sublingual and buccal routes can beused for quicker therapy, and they can be used when a smaller dose ofdrug is needed for immediate therapy. The latter routes can be used as aby-pass of the first pass of hepatic metabolism of the drug.

[0068] In summary, it will be appreciated that the present inventioncontributes to the art an unobvious dosage form that possesses practicaltherapeutic utility, and it can administer a drug at a dose-meteredrelease rate per unit time.

We claim:
 1. A method for the management of incontinence in a patient,wherein the method comprises admitting orally into the patient a dosageform comprising a member selected from the group consisting ofoxybutynin and its pharmaceutically acceptable salt, that isadministered at a release rate of 0.05 mg per hour up to 0.850 mg perhour for the management of incontinence in the patient.
 2. The methodfor the management of incontinence in a patient according to claim 1,wherein the dosage form is a sustained-release dosage form and thepharmaceutically acceptable salt is a member selected from the groupconsisting of acetate, bitartrate, citrate, edetate, chloride,edisylate, estolate, esylate, fumarat, gluceptate, gluconate, glutamate,bromide, lactate, malate, maleate, mandelate, mesylate, methylnitrate,mucate, napsylate, nitrate, pamoate, pantothenate, phosphate,salicylate, stearate, succinate, sulfate, tannate, and tartrate.
 3. Themethod for the management of incontinence in a patient according toclaim 1, wherein the dosage form is a controlled-release dosage form andthe oxybutynin is present as a racemate.
 4. The method for themanagement of incontinence in a patient according to claim 1, whereinthe dosage form is a member selected from the group consisting of atablet, capsule, caplet, bead, and matrix and the oxybutynin is presentas the R-enantiomer.
 5. The method for the management of incontinence ina patient according to claim 1, wherein the dosage form is a memberselected from the group consisting of a tablet, capsule, caplet, beadand matrix and the oxybutynin is present as the S-enantiomer.
 6. Amethod for treating incontinence in a patient exhibiting the symptoms ofincontinence, wherein the method comprises admitting orally into thepatient a sustained release dosage form comprising 240 ng to 650 mg of amember selected from the group consisting of oxybutynin and itspharmaceutically acceptable salt that is administered at aincontinence-managing rate of 10 ng per hour to 20 mg per hour for themanagement of incontinence.
 7. The method for treating incontinence in apatient according to claim 6, wherein the method administers thepharmaceutically acceptable salt oxybutynin chloride over 24 hours.
 8. Amethod for the management of incontinence and for the management ofhormone replacement therapy in a patient, wherein the method comprisesadministering a sustained-release therapeutically effective dose of amember selected from the group consisting oxybutynin and itspharmaceutically acceptable salt for the management of incontinence, andadministering a therapeutically effective dose of an estrogenic steroidfor the management of hormone replacement therapy to the patient in needof both therapies.
 9. The method for the management of incontinence andfor the management of hormone replacement therapy according to claim 8,wherein the oxybutynin and the estrogenic steroid are administered atthe same time.
 10. The method for the management of incontinence and forthe management of hormone replacement therapy according to claim 8,wherein a progestin is administered with the estrogenic steroid.
 11. Themethod for the management of incontinence and for the management ofhormone replacement therapy according to claim 8, the oxybutynin and theestrogenic steroid are administered at a different time.
 12. The methodfor the management of incontinence and for the management of hormonereplacement therapy according to claim 8, wherein the administration ofthe estrogenic steroid is accompanied by the administration of aprogestin steroid as a steroid pair and at a different time from theadministration of the oxybutynin.
 13. The method for the management ofincontinence and for hormone replacement therapy according to claim 8,wherein the estrogenic steroid is a conjugated equine estrogen.
 14. Amethod for treating involuntary incontinence in a patient, wherein themethod comprises admitting orally into the patient a sustained releaseonce-a-day dosage form comprising 240 ng to 650 mg of a member selectedfrom the group consisting of oxybutynin and its pharmaceuticallyacceptable salt, that is administered in a sustained rate to provide inthe plasma of the patient a higher oxybutynin/desethylmetabolite ratiothen about 0.18 to 1 for treating involuntary incontinence in thepatient.
 15. A method for managing the concentrations of oxybutynin(OXY) and its desethylmetabolite (DESOXY) in the plasma of a patient,and for managing incontinence in the patient, wherein the methodcomprises admitting orally into the patient a once-a-day dosage formcomprising 240 ng to 650 mg of a member selected from the groupconsisting of oxybutynin and its pharmaceutically acceptable salt, thatis administered at a controlled rate to provide higher OXY/DESOXY ratiothen about 0.18 to 1 for managing the plasma concentrations and formanaging incontinence in the patient.
 16. A method for the management ofoveractive bladder and for increasing compliance in a patient in need ofsaid management and compliance wherein the method comprises admittingorally into the patient a once-a-day dosage form comprising 240 ng to650 mg of a member selected from the group consisting of oxybutynin andits pharmaceutically acceptable salt that is administered in asustained-release dosage of 0.10 ng per hour to 25 mg per hour forincreasing patient compliance for the management of overactive bladderin the patient.
 17. The method according to claim 16, wherein the dosageform comprises a polymer selected from the group consisting of anerodible, nonerodible, diffusion, ion-exchange, and porous polymers. 18.The method according to claim 16, wherein the dosage form is an osmoticdosage form.
 19. The method according to claim 16, wherein the dosageform comprises tiny pills.
 20. The method according to claim 16, whereinthe patient is administered a member selected from the group consistingof an estrogen and a progestin.
 21. The method according to claim 16,wherein the dosage form comprises drug releasing beads.
 22. A method fortreating an overactive bladder in a female patient, wherein the methodcomprises admitting orally into the patient a dosage form comprising amember selected from the group consisting of oxybutynin and itspharmaceutically acceptable salt that is administered in a controlledrelease dose of 0.05 mg per hour to 0.850 mg per hour for treating theoveractive bladder in the female patient.
 23. The method for treatingthe overactive bladder according to claim 22, wherein the dosage formcomprises a member selected from the group consisting of poly(amide),poly(amino acid), poly(ester), poly(lactic acid), poly(glycolic acid),poly(orthoester), poly(orthocarbonate), poly(acetyl), poly(anhydride),poly(dehydropyran), poly(carbohydrate), and poly(dioxinone).
 24. Themethod for treating the overactive bladder according to claim 22,wherein the dosage form comprises a member selected from the groupconsisting of an olefin, vinyl, condensation, addition, carbohydrate,and silicon polymer.
 25. The method for treating the overactive bladderaccording to claim 22, wherein the dosage form comprises a memberselected from the group consisting of hydroxypropylalkylcellulose, andhydroxyalkylcellulose.
 26. The method for the management of overactivebladder and hormone replacement therapy in a female patient, wherein themethod comprises orally administering to the patient a member selectedfrom a group consisting of oxybutynin and its pharmaceuticallyacceptable salt at a sustained release rate for the management of theoveractive bladder, and orally administering to the patient acomposition comprising a steroid selected from the group an estrogen anda progestin for hormone replacement therapy.
 27. The method for themanagement of overactive bladder and hormone replacement therapyaccording to claim 26 wherein the oxybutynin and the steroid areadministered at the same time.
 28. The method for the management ofoveractive bladder and hormone replacement therapy according to claim26, wherein the oxybutynin and the steroid are administered at differenttimes.
 29. The method for the management of overactive bladder andhormone replacement therapy according to claim 26, wherein the estrogenis a member selected from the group consisting of estradiol, estradiolvalerate, estradiol benzoate, estradiol cypionate, estradiol propionate,estradiol dipropionate, estradiol acetate, ethinyl estradiol,17α-ethinyl estradiol, 17α-ethinyl estradiol esters, 17α-ethinylestradiol acetate, 17α-ethinyl estradiol benzoate, 17α-ethinyl estradiolethers, estrone, estrone acetate, estrone sulfate, estriol, estriolsuccinate, estriol triacetate, conjugated equine estrogens, andestradiol esters.
 30. The method for the management of overactivebladder and hormone replacement therapy according to claim 26, whereinthe progestin is a member selected from the group consisting ofprogesterone, medroxyprogesterone, medroxyprogesterone acetate,hydroxyprogesterone, hydrogesterone caproate, norethindrone,norethindrone acetate, megestrol, megestrol acetate, progestin,progestogin, norgestrel, norethisterone, norethisterone acetate,levonorgestrel, norgestimate, norethynodrel, 17-hydroxyprogesteroneesters, 19-nor-17-hydroxyprogesterone, 19-nor-17-hydroxyprogesteroneesters, 17α-ethinyltestosterone, 17α-ethinyl-19-nortestosterone,d-17β-acetoxy-13β-ethyl-17α-ethinyl-17β-hydroxygon-4-en-3-one,13β-ethyl-17β-hydroxygon-4-en-3-one,13β-17α-diethyl-17β-hydroxygon-4-en-3-one, chlormadione acetate,dimethistrone, 17α-ethinyl-β-acetoxy-19-norandrost-4-en-3-one oxime,3-ketodesogestrel, desogestrel, gestodine, and gestodene acetate. 31.The method for the management of overactive bladder and hormonereplacement therapy according to claim 26, wherein the oxybutynin isadministered from a dosage form selected from the group consisting ofosmotic, diffusion, erodible, nonerodible, and ion-exchange dosageforms.